A primary cutaneous melanoma* that has not yet metastasized is curable by excision in toto; no additional treatment is required. Once metastasis of melanoma becomes apparent clinically, it is likely that if the patient lives long enough and does not die of something else, death, in time, will occur from the effects of metastases. Whether that will happen in months or decades, cannot be determined. A patient may have a metastasis of melanoma that is not evident clinically or by any kind of examination available currently and that person's destiny also is sealed. Nowadays, a patient presumed to have a metastasis of melanoma is given three options: 1) elective lymph node dissection (END),** an operation that was introduced in the nineteenth century, 2) adjuvant medical therapy, the one most in vogue currently being interferon, and 3) sentinel lymph node biopsy (SNB), a procedure proposed at the end of the twentieth century for the purpose of diagnosing a metastasis of melanoma in a node when no node is palpable clinically.

These three modalities have been studied and written about extensively; all three remain controversial and, as a consequence, the legitimacy of them is debatable. This endeavor by us was undertaken in order to assess critically each of the three modalities. We sought to accomplish the desideration by reviewing incisively the important medical literature that pertains to each of them, by elucidating major matters of controversy in regard to END, adjuvant medical therapy, and SNB, and by analyzing each of the issues in a logical, insightful, unbiased manner. The objective, in short, is to make these subjects readily comprehensible and, by virtue of that, to lead a reader, in Socratic fashion, to conclusions that are compelling because the evidence for them is so powerfully incontrovertible. If that goal is achieved, as we are confident it will be, then patients will be beneficiaries ultimately. That is our modus operandi and what follows is animated by the mentality and the spirit just enunciated.